Treatment and management of advanced heart failure in elderly

Abstract

Heart failure (HF) is a life-limiting condition, associated with high morbidity. End-stage, known as advanced heart failure (AHF), is more common among the elderly. HF patients’ disease trajectory is more variable and unpredictable than the trajectory for most oncologic illnesses. Despite a growing armamentarium of resources the management of AHF patients can be complex. Advances in medical therapy have dramatically improved the quality of life and survival of patients with end-stage HF. The majority of studies reveal lack of knowledge of HF among elderly patients. Mechanical circulatory support can provide bridge-to-transplantation therapy in eligible patients or destination therapy in those ineligible for heart transplantation like the majority of elderly patients with HF. The palliative care stage, considered as treatment basically aimed at controlling symptoms, may last a long time in some patients and should not simply be regarded as the final phase. Studies show that patients with AHF may have a poor understanding of their condition and its outcome and, therefore, guidelines recommend health care professionals to have an open communication with patients and their families about the AHF trajectory, including discussing their preferences for future care, acknowleding the risk of a sudden death, and the possibility of deactivation of devices (i.e. implantable defibrillators) in the end-of-life. This contribution is an attempt to have a brief overview of strategies for the management of HF terminal stage in elderly.